Gastrointestinal (GI) cancers represent 26% of the global cancer incidence and more than one-third of all cancer-related deaths . Patients with upper GI cancers have a higher risk of venous thromboembolism than patients with other malignancies .
GI cancers are highly invasive and metastatic, and in many cases, they are associated with a poor prognosis. Innovative and wide-ranging treatments have been developed over the years, but their efficacy differs among individuals . For these reasons, there is a great need for new prognostic biomarkers for the prediction of survival and predictive biomarkers for treatment efficacy or toxicity.
A recent study analyzed a large prospective cohort of patients with newly diagnosed metastatic GI cancer enrolled in the ongoing multicenter observational HYPERCAN study (NCT02622815)  to evaluate the capability of plasma hemostatic biomarkers (measured before starting chemotherapy) to predict early disease progression at 6 months and 1-year overall survival (OS) .
The study population included 626 newly diagnosed metastatic GI patients from eight Italian oncology units enrolled between May 2012 and November 2019 in the HYPERCAN study .
Inclusion criteria were:
- Newly diagnosed metastatic colorectal cancer (CRC) or gastric cancer (GC), stage TXNXM1
- Being a candidate for systemic chemotherapy
Exclusion criteria were:
- Acute medical illnesses
- Therapeutic anticoagulation
- Life expectancy <3 months
The study population included 462 CRC and 164 GC with a median age of 66 years (range: 26–87 years), 61% of which were male.
The analysis wanted to unveil if prechemotherapy values of hypercoagulation biomarkers and endogenous thrombin potential (ETP) may be predictive for disease progression at 6 months and 1-year OS .
Disease progression at 6 months was observed in 25.6% of patients with metastatic GI, more in GC (46.2%) than CRC (18.8%).
The multivariate model, stratified for age, site of tumor, and number of metastases, identified D-dimer >420 ng/mL (Subdistribution Hazard Ratio, SHR = 1.4, 95% CI: 1.1–2.1; p=0.047) and ETP >1700 nM·min (SHR = 1.6, 95% CI: 1.1–2.2; p=0.014) as independent risk factors for disease progression at 6 months .
During the first year of follow-up, a total of 139 deaths were recorded, providing a 75.2% overall survival, with a better prognosis in CRC patients compared to GC (83.0% vs 51.1%). Again, elevated values of D-dimer and ETP were independent risk factors for 1-year OS .
Data on the type of chemotherapy, molecular markers (HER-2), and genetic mutations (KRAS, NRAS, and BRAF) were unavailable for all patients and were not included in the analysis. In addition, biomarker measurements are single-point and not repeated during follow-up .
D-dimer and ETP can help identify patients at high risk for disease progression at 6 months and death. These predictors could improve the prognosis evaluation of patients with cancer, providing useful information on the type and intensity of the anticancer treatment to be administered .
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